The Health 202: Nursing home residents may account for one-half of all U.S. coronavirus deaths

The nation’s nursing homes — housing many of the most vulnerable Americans — are ground zero in the devastation wrought by the novel coronavirus.

Look no further than Maryland, where cases are spreading as many residents still don’t receive testing, workers struggle to obtain sufficient protective equipment and managers play down the severity of the outbreaks.

In this extensive report, my colleagues Rebecca Tan and Rachel Chason spoke with former and current staff members of Sagepoint Senior Living Center and six other Maryland facilities. Staffers at several facilities said they weren’t provided with masks and gowns until patients had tested positive. An administrator sleeps overnight at one Silver Spring center because of staff shortages.

Sagepoint Senior Living Center experienced in one of the largest coronavirus outbreaks in the state of Maryland. (Marvin Joseph/The Washington Post)

At Potomac Valley Rehabilitation and Healthcare in Rockville, a nurse said patients who have tested positive for the coronavirus are “all over” the building even though managers say those patients are separated from others.

The daughter of one Potomac Valley resident reached out to me to share her frustrations with the lack of testing and communication from the center. Kim Peyser, whose 74-year-old mother has lived in the facility since 1991 because of a traumatic brain injury, shared two letters from the facility’s administrators saying patients who tested positive were being isolated from others.

In an April 24 phone conversation with a social worker, Peyser said she probed for information about how many patients in the facility had tested positive, whether staff was getting tested and why her mother hadn’t been tested.

Peyser said she wasn’t able to get satisfactory answers. And her mother isn’t able to communicate sufficiently to answer any questions herself.

“Our conversation was frustrating at best,” Peyser told me. “I asked how many cases are there. She said a couple. So that ended that unsatisfying conversation.”

Last week, Gov. Larry Hogan (R) ordered universal testing for residents of the state's 226 long-term care facilities. He also signed a contract for 260 medical professionals to help with staffing and directed the state’s health department to list online the confirmed cases and fatalities at all the nursing homes.

But nursing home staff say it’s all coming late.

“Nursing home employees said the help has been slow to materialize, and the staffing won’t cover yawning gaps,” Rebecca and Rachel write.

“The death toll at Sagepoint is the highest among nursing homes in Maryland, where long-term care facilities accounted for more than 6,000 of the state’s coronavirus infections as of Wednesday and 804 confirmed covid-19 deaths,” they add. “More than 1,900 employees of such facilities had contracted the virus, according to a state database.”

Erin Cox, Maryland politics reporter for The Washington Post:

Head of Md's nursing home association: "The reality is ... they're aren't enough tests on the ground right now. They don't exist."A week ago @GovLarryHogan announced universal testing in nursing homes. But nursing home leader tells lawmakers that's not happening and impossible

Peyser only found out details about Potomac Valley once the web page went up and showed there were 18 confirmed cases among residents and staff members at the time.

Montgomery County health officials said that because of the pandemic they haven’t conducted in-person compliance visits as usual. The federal Centers for Medicare and Medicaid Services suspended non-emergency inspections March 4.

“At this point, we’re taking their word for it,” a clinical nurse administrator at the county Department of Health and Human Services told Rebecca and Rachel when asked how the county is ensuring that facilities are abiding by regulations.

He said the state had sent inspectors to 10 long-term care facilities in the county. But some nursing homes were declining the visits, said Enrico Lachicha, a clinical nurse administrator at the county Health and Human Services Department. Hogan’s April 29 order made compliance mandatory.

A health-care worker helps an elderly person exit an ambulance at the Southeast Nursing and Rehabilitation Center in San Antonio, Tex. (Go Nakamura/Reuters)

About one-third of U.S. residents who have died of the novel coronavirus resided in a long-term care facility.

Media reports have suggested more than 20,000 of the 71,000 coronavirus deaths in the United States were from nursing homes. That’s probably an underestimate because of incomplete reporting and testing shortages. This week, New York City officials disclosed more than 1,600 additional deaths of people presumed to have died of the virus but who were never diagnosed with it.

Expert say — and initial reports from European countries suggest — once the pandemic has subsides, roughly half of all deaths may be found to have occurred in assisted living homes. States are still collecting data, but so far six have reported that residents of nursing homes accounted for more than half their deaths, according to analysis by the Kaiser Family Foundation.

The numbers are murky in part because the Centers for Disease Control and Prevention hasn’t released details on how many deaths were among nursing home residents.

Two Senate Democrats — Ron Wyden of Oregon and Bob Casey of Pennsylvania — called yesterday on the Trump administration to rectify the situation and commit to a timeline to release the information.

“There have been no signs that the Trump administration has an effective plan to address the tragedy that is taking place in America’s nursing homes,” they said in a joint statement.

Hogan isn’t the only governor struggling to protect nursing homes. More than one-fifth of the country’s nursing home deaths have occurred in New York City, where Gov. Andrew Cuomo (D) issued a policy requiring nursing homes to accept patients with the coronavirus but keep them isolated from other patients.

(Stephanie Lecocq/EPA-EFE/Shutterstock)

Yesterday, Potomac Valley’s case count was upgraded from 18 to 52 cases — and six deaths.

It’s frightening for Peyser to watch, as she continues to fear for her mother’s life. Her father, Peter Peyser, has also left multiple phone messages with the facility’s administration, only to have the calls unreturned.

An employee there told my colleagues staffers pleaded with administrators for protective gear throughout March, to no avail. Documents they obtained show a supervisor telling staffers such equipment was in short supply and that they could bring in their own if they wanted to do so.

The employee said there are coronavirus-positive patients all over the facility, in contrast with two letters from administrators saying coronavirus-positive residents were being isolated in a separate wing with “designated staff."

“Documents obtained by The Post say residents who have the virus and residents suspected of having the illness are being housed in all four of the facility’s wings,” my colleagues write.

Welcome to The Health 202, our must-read newsletter on health policy.

Ahh, oof and ouch

AHH: Trump now says the coronavirus task force will continue “indefinitely” after telling reporters on Tuesday it would soon be disbanded.

“I thought we could wind it down sooner, but I had no idea how popular the task force is until actually yesterday when I started talking about winding down,” Trump said after signing a proclamation in the Oval Office honoring nurses. “It is appreciated by the public.”

The White House CoronaVirus Task Force, headed by Vice President Mike Pence, has done a fantastic job of bringing together vast highly complex resources that have set a high standard for others to follow in the future. Ventilators, which were few & in bad shape, are now being....

....gloves, gowns etc. are now plentiful. The last four Governors teleconference calls have been conclusively strong. Because of this success, the Task Force will continue on indefinitely with its focus on SAFETY & OPENING UP OUR COUNTRY AGAIN. We may add or subtract people ....

The day before, Trump told reporters the administration would instead probably “have a different group,” and Vice President Pence said officials were discussing winding down the task force within a month.

“The evolving messages reflect a persistent tension within the administration — and the country — over when it will be safe to put the pandemic in the rearview mirror and end the government-imposed restrictions that have slowed the virus’s spread but crippled the nation’s economy,” Matt Zapotosky and John Wagner report.

“Privately and publicly, Trump has pushed to reopen the country, though the decision to do so lies more with the governors who have ordered businesses closed in their states. But each time the president or state leaders take a step toward reopening, they are confronted with the reality that the pandemic is far from over and expert warnings that resuming regular activity too soon would exacerbate the destruction unleashed by the coronavirus.”

Trump looks at an assembly line during a tour of Honeywell's facility manufacturing protective face masks for the coronavirus pandemic in Phoenix, Arizona. REUTERS/Tom Brenner - RC2MIG9YOUY7/File Photo

OOF: The Justice Department is investigating a contractor that failed to provide medical equipment to Maryland and California.

The firm, Blue Flame Medical, was created by two well-connected Republican operatives. The two states ultimately canceled contracts with the company, which pledged to send medical masks and other equipment, Tom Hamburger and Juliet Eilperin report.

Last weekend, Maryland terminated a $12.5 million contract for personal protective equipment (PPE) with the firm after state officials said the company had failed to deliver masks and ventilators as promised.

California had separately hired the firm to provide 100 million face masks. That contract, first reported Wednesday by the California news website CalMatters, was then abruptly canceled, and the state scrambled to get its $457 million deposit back. The funds were returned the same day.

Ethan Bearman, a company attorney, said Blue Flame acted in good faith but did not comment on the Justice Department probe.

The Justice Department’s interest was piqued when California suddenly canceled its contract. “A person familiar with the inquiry said that while the Justice Department is studying the transactions, there has been no indication so far that charges will be filed,” Tom and Juliet write.

Michael Ricci, a spokesman for Maryland Gov. Hogan (R), confirmed the state has received subpoenas from federal prosecutors seeking information about the canceled Blue Flame contract, but wouldn't say what information they're seeking.

OUCH: Alex Azar suggested meat plant workers are getting the virus more because of their “home and social” situations than because the virus is circulating at the packing facilities.

The Health and Human Services secretary said on an April 28 call with lawmakers that he believed infected employees were bringing the virus into processing plants, Politico's Adam Cancryn and Laura Barron-Lopez report. Outbreaks in these facilites have forced nearly two dozen plants to close and killed at least 20 workers, three people on the call told Adam and Laura.

“Azar emphasized the need to keep the plants open, according to the three people on the call,” they write. "He also theorized that workers were largely not becoming infected at the meatpacking plants, and were instead contracting the coronavirus from their communities.

“Azar noted in particular that many meatpacking workers live in congregate housing, allowing that more testing at facilities would help but that the bigger issue was employees' home environments. One possible solution was to send more law enforcement to those communities to better enforce social distancing rules, he added, according to two of the lawmakers on the call.”

Nearly a fifth of young U.S. children aren’t getting enough to eat during the pandemic lockdowns.

New research found 17.4 percent of surveyed mothers with children ages 12 and under said since the pandemic began, kids in their house “were not eating enough because we just couldn’t afford enough food.” Of those, 3.4 percent said it was “often” that their children weren’t eating enough because of a dearth of resources since the lockdowns started, according to the survey conducted by the Hamilton Project and the Future of the Middle Class Initiative, which are affiliated with the Brookings Institution.

School lunch worker Brenda Alexander wears a mask as she prepares to distribute meals at an apartment complex in Dallas. (LM Otero/AP)

The rate of young children not getting enough food is three times as high as in 2008, during the last decade’s Great Recession.

“When food runs short, parents often skip meals to keep children fed,” the New York Times reports.

Lauren Bauer, a Brookings fellow in economic studies who led the study, called the findings “alarming.” “These are households cutting back on portion sizes, having kids skip meals. The numbers are much higher than I expected,” she added. She pointed to the halt of school meals as one possible problem contributing to the food insecurity.

“Democrats and Republicans are at odds over proposals to raise food stamp benefits,” the Times writes. “Democrats want to increase benefits by 15 percent for the duration of the economic downturn, arguing that a similar move in 2009 reduced hunger during the Great Recession. Congress has enacted a short-term increase for about 60 percent of the caseload, but the increase omits the poorest recipients."

Trump administration efforts

Trump has tapped Derek Lyons to lead his domestic policy office, taking the place of Joe Grogan.

Lyons, who currently serves as the White House staff secretary, will be the next acting head of the White House’s domestic policy office, a post that’s set to play a critical role in Trump’s ongoing push to reopen the country, Politico’s Anita Kumar and Daniel Lippman report.

White House Domestic Police Council Director Joe Grogan listens as President Trump participates in an event at the White House. (Jabin Botsford/The Washington Post)

Lyons is expected to keep his staff secretary job “when he succeeds Joe Grogan as director of the Domestic Policy Council, according to the two White House officials. Grogan announced his resignation last week,” they write.

“If Trump wins a second term in November, the DPC head would help shape the policy goals of the first 100 days, a benchmark for a president to showcase his priorities,” Anita and Daniel add. “During his year-plus as DPC head, Grogan emerged as an influential figure on most key health care policies, including drug pricing and the effort to ban ‘surprise’ medical bills.”

Industry impact

Paramedics are taking a financial hit even as they fight this pandemic on the front lines.

Hospitals dealing with a crush of coronavirus cases are calling on paramedics to only bring critically ill patients to emergency rooms.

But for ambulance services that are often only reimbursed by insurers if patients are relocated, that means millions in lost revenue, the Wall Street Journal’s Sarah Krouse reports.

An ambulance sits in the emergency room bay of Lincoln Medical Center in the Bronx. (David Dee Delgado/Getty Images)

“The revenue shortfalls from treating 911 callers wherever they were, along with the rising cost of protective gear, creates a financial squeeze for emergency medical services on the front lines of the pandemic,” she writes. “Some ambulance services are funded solely by transport payments from Medicare and insurers, while others receive public funding or are embedded with other public-safety agencies that help support their finances.”

Last year, the Centers for Medicare and Medicaid Services picked about 200 ambulance organizations to test a program to enable such emergency services to get Medicare reimbursement even when they treat patients in place, but that pilot program has been delayed amid the pandemic, Sarah reports.

Advocates are reviving calls for drug price controls amid the race to find a coronavirus treatment.

They want the next coronavirus response package to include measures that would ensure Gilead Sciences, which makes the antiviral drug remdesivir, does not have exclusive rights to treatments and vaccines for the coronavirus, Bloomberg Law’s Alex Ruoff reports.

The Ebola drug remdesivir is shown during a news conference at the University Medical Center Hamburg-Eppendorf in Hamburg. (Ulrich Perrey/Pool/Reuters)

The drug recently received emergency use authorization from the Food and Drug Administration to allow doctors to use the drug to treat patients hospitalized with serious covid-19 cases.

Eli Zupnick, spokesman for the group Patients Over Pharma, said: “While we all hope that remdesivir pans out as an effective covid-19 treatment, there is absolutely no reason to trust that Gilead would make it affordable and accessible for patients if doing so hurt their bottom line.”

Lower Drug Prices Now and other groups have been “sending messages to lawmakers and buying digital ads outlining Gilead’s pricing decisions in the past: setting the cost of its Hepatitis C drug at $1,000 per pill and reaping billions of dollars in profits from its HIV drug Truvada. The group also organized a petition to be sent to lawmakers calling for action on drugs related to Covid-19,” Alex writes.

Congress on coronavirus

They wrote a letter to the Department of Health and Human Services citing the administration’s own plans for addressing the pandemic and assessing any shortages in critical supplies.

Volunteers from MoveOn set up some 1,000 signs featuring the faces of front-line health-care workers and signs calling for more personal protective equipment in front of the U.S. Capitol. (Evelyn Hockstein for The Washington Post)

“In March, the Administration authored a report that outlined critical information that should be collected to address shortages in PPE as a part of the Administration’s greater strategy to address the COVID-19 pandemic,” reads the letter to HHS Secretary Alex Azar, which was sent to The Health 202. “To date, it remains unclear if this information is being collected. If it is, the data are not being shared with Congress.”

Warren and Casey want the agency to provide information, no later than May 15, about any PPE shortages it's monitoring, including the types of supplies that are in limited supply and the types of facilities that are seeing gaps. They also called for additional information, including whether the federal government is securing PPE from foreign sources and how it's protecting against any vulnerabilities in supply chains.

Coronavirus latest

A few more headlines and developments to catch up on this morning:

More from the Trump administration:

Trump called the effort to provide protective medical equipment “tremendous,” contradicting a nurse who said at a White House meeting there were areas around the country without adequate protective supplies, Bloomberg News’s Jordan Fabian reports.

The Internal Revenue Service issued some stimulus payments in the name of people who have died. Now, the agency says those checks have to be returned, Michelle Singletary reports.

White House press secretary Kayleigh McEnany said it was “nonsensical” to say all Americans would need to be tested for the coronavirus. “If we tested every single American in this country at this moment, we’d have to retest them an hour later, and then an hour later after that, because at any moment you could theoretically contract this virus,” she said in response to a question about whether Americans should get tested before returning to work.

Around the world:

Several prominent leaders in the world’s pandemic response have been caught breaking social distancing rules. “British epidemiologist Neil Ferguson, a key adviser to the British government on its coronavirus response, resigned after The Telegraph reported that he broke lockdown protocol when a woman the newspaper described as his lover visited him at home,” Siobhán O'Grady writes.

The hardest hit:

Counties where black people make up a disproportionate share of the population account for more than half of the coronavirus cases and nearly 60 percent of the deaths in the United States, according to a study by an AIDS research group, Vanessa Williams reports.

Hispanics are nearly twice as likely as whites to have lost their jobs amid the shutdowns, a new Washington Post-Ipsos poll has found. “The poll finds that 20 percent of Hispanic adults and 16 percent of blacks report being laid off or furloughed since the outbreak began in the United States, compared with 11 percent of whites and 12 percent of workers of other races,” Tracy Jan and Scott Clement report.

On the front lines:

Thousands of Americans are facing a dilemma of whether to continue to receive the help of home health workers or isolate themselves to prevent contracting the virus. “A recent survey conducted by the National Association for Home Care and Hospice found that 42 percent of home health aides were treating patients who had tested positive for covid-19, according to William A. Dombi, president of the home-care association,” Chelsea Janes reports.

Crawling toward a new normal:

Nordstrom and Gap will slowly reopen their stories, but there will be new protocols in place for shoppers and employees, including closed bathrooms and fitting rooms, quarantined returns and face masks and hand sanitizer, Abha Bhattarai and Taylor Telford report.

Starbucks, too, will reopen 85 percent of its coffee shops by the end of this week. There will be new voice ordering and curbside pickup options, as well as an emphasis on mobile orders and contactless pickup, Abha writes.